Predictors of Disability and Quality of Life After Nerve Injury

PURPOSE: The purpose of this study was to understand the wide range of problems people with upper-extremity peripheral nerve disorders (UE-PND) experience and to identify predictors of disability and quality of life (QOL). Hand therapy historically focuses on remediating sensorimotor deficits, yet small studies in this population identified disruptions in basic and instrumental activities of daily living and work and depression issues. Measurement of the prevalence of these problems in a large sample will help us better understand this population’s needs and design client-centered rehabilitation plans to enhance participation.

DESIGN: All adult patients presenting to a nerve surgeon were recruited to participate in this retrospective cross-sectional research. Data from consenting patients with UE-PND diagnosis were extracted from medical records and entered into secure database and analyzed with IBM SPSS Statistics.

METHOD: Standardized assessments included the Disabilities of the Arm, Shoulder, and Hand (DASH), Work DASH, and Short Form 36 Health Survey. A self-report questionnaire measured pain, depression, stress at home and work, and ability to cope with stress on 100-point scale, in addition to problems with sleep and intimate relationships. Physical examination and demographic data were included. Descriptive and inferential statistics were computed and compared between groups. Four multivariate linear regression models were built for disability, work disability, and physical and mental QOL. Variables with positive correlations >.25 (p < .01) were included in regression models, and collinear predictors (>.70) or those closely tied to the dependent variable were excluded. Age and sex were forced into all models.

RESULTS: Our sample demonstrated substantial disability and even greater work disability, which both closely correlated with poorer quality of life. Employed patients (71% of the sample) had less disability and better QOL (p < .01) than unemployed patients. Variables found to predict disability in prior research (workers’ compensation, diagnosis, and symptom duration) did not meet criteria for inclusion in multivariate models due to bivariate correlations. Depression accounted for the highest variance in the disability multivariate model; inability to work and higher pain were also major predictors of disability. Problems with sleep, intimate relationships, and household chore performance predicted 46% of work disability (R ² = .463). In multivariate QOL models, disability accounted for significant variance in both physical and mental QOL, and work disability was a major predictor of physical QOL. Pain was predictive of mental QOL but not physical QOL.

CONCLUSION: Patients with UE-PND presenting to a nerve surgeon displayed a high degree of disability and work disability and lowered physical and mental QOL. The strong relationship between disability and QOL emphasizes the importance of helping patients learn to perform basic and instrumental activities of daily living and maintain meaningful work and community roles. Strength and pain, issues commonly addressed in work rehabilitation, did not predict work disability; however, ability to perform other occupations (sleep and household chores) did, suggesting a focus shift to occupational performance. Helping patients identify ways to maintain home and community roles may facilitate resumption of worker roles. Helping patients cope with emotional issues and prevent intimate relationship and sleep problems is important in this population. Occupational therapists should broaden treatment approaches beyond remediation to adapt environments and tasks, teach compensatory strategies, prevent disability, and promote health and QOL.

References

Bailey, R., Kaskutas, V., Fox, I., Baum, C., & Mackinnon, S. (2009). Effect of upper-extremity nerve damage on activity participation, pain, depression, and quality of life. Journal of Hand Surgery, 34, 1682–1688. https://doi.org/10.1016/j.jhsa.2009.07.002

Chemnitz, A., Dahlin, L., & Carlsson, I. (2013). Consequences and adaptation in daily life—Patient experiences three decades after nerve injury sustained in adolescence. BMC Musculoskeletal Disorders, 14, 252. https://doi.org/10.1186/1471-2474-14-252

Novak, C., Anastakis, D., Beaton, D., Mackinnon, S., & Katz, J. (2011). Biomedical and psychosocial factors associated with disability after peripheral nerve injury. Journal of Bone and Joint Surgery, 93, 929–936. https://doi.org/10.2106/JBJS.J.00110